Early disease detection through percutaneous needle biopsies is considered the gold standard for cancer diagnoses and thus for obtaining good health outcomes. This project seeks to ameliorate health disparities by making it possible for general practitioners and other health professionals to perform image-guided needle biopsies in their own office or clinic rather than sending patients with suspect lesions to distant centers. Th key enabling technology is an ultrasound-based guidance system designed to provide intuitive and reliable in-situ guidance that can be used by interventionalists with minimal training, allowing doctors to perform needle biopsies on patients in their own clinic or office. The project consists of three aims. The first aim will develop and evaluate an easy-to-use guidance system for targeted needle biopsy by focusing on the development of the guidance platform itself, including device construction, internal calibration, interfaces to the ultrasound system, and the development of several guidance modes. The second aim will extend guidance system with registration between pre-operative CT and ultrasound foriImage-guided interventions, by providing new algorithms for ultrasound- and surface- to CT registration, making it possible for expert annotations of critical structures to be transferred to the guidance system directly. The third aim will evaluate the system on phantom models and in a pilot animal study by practitioners of varying skill and training levels, and comparing it to state-of-the-art guidance systems. The third aim includes the creation of a health disparity advisory board to guide the further development of the device for deployment to reduce health disparities in rural and underserved populations.